The	I–Gaze	Interweave	for	Attachment	Repair	in	EMDR	Therapy	
        ABSTRACT          	
        Approximately 40% of the general population suffers from an insecure attachment style 
        from infancy.  These individuals are disproportionately represented in the psychotherapy 
        population.  Seen as a scalar phenomenon, the presentation of insecure attachment can 
        range from an occult co-morbidity of anxiety and depression to disabling personality 
        disorders, intractable relational dysfunction, and self-harm.  The associated symptoms of 
        depersonalization, psychic numbing, and affect dysregulation present serious clinical 
        challenges for which specialized interweaves may be necessary. The proposed interweave 
        offers additional dyadic resourcing to facilitate resolution of attachment trauma.  The 
        literature on attachment and social engagement in mammals is replete with evidence of 
        the salience of eye-gazing between parents and children, as well as between adults.  The 
        I-Gaze protocol involves an interweave in which the therapist sits knee-to-knee with the 
        client and gazes into one of the client's eyes throughout phase four, utilizing bilateral 
        tapping as the dual attention stimulus. It is proposed that this recapitulation the original 
        parent-infant attachment paradigm can enhance dyadic resourcing and install a profound 
        felt-sense of earned secure attachment within the intersubjective realm of the therapeutic 
        relationship.  
         
        Keywords: eye movement desensitization and reprocessing (EMDR) therapy; attachment; 
        attachment trauma; depersonalization; eye-gaze; interweave; case study; intersubjective 
         
        INTRODUCTION 
        Bowlby's (1969) attachment theory describes the primacy of the infant-parent (usually the 
        mother) relationship in psychological development. The lasting effects of early childhood 
        attachment influence personality structure, emotional regulation, mentalization, empathy, 
        relational functioning, and coping strategies (Fonagy,1991, Riggs, 2010; Schore, 2012). 
        Insecure attachment––independent of physical or sexual abuse––amounts to an 
        attachment trauma that can have profound effects of the development of psychopathology 
        (Davila, Ramsay, Stroud, & Steinberg, 2005; Sroufe, Carlson, Levy, & Egeland, 1999). 
         
        In their analysis of over 10,000 Adult Attachment Interview studies of mothers in the 
        general population, Bakermans-Iranenburg & Van IJzendoorn (2009) determined that the 
        normal distribution of attachment styles is as follows: 58% securely attached, 23% 
        dismissive, 19% preoccupied, and 18% unresolved. Fully 42% of the general population 
        therefore have an insecure attachment style. Given the disproportionately high incidence 
        of psychopathology in this group (Mickelson, Kessler, & Shaver, 1997), including 
        personality disorders (Meyer, Pilkonis, Proietti, Heape, & Egan, 2001) and posttraumatic 
        stress and dissociation (Sandberg, 2010), it is reasonable to expect their disproportionate 
        representation as psychotherapy clientele. 
         
        Shapiro's (2001) Adaptive Information Processing model characterizes attachment 
        traumas amounting to an insecure attachment style as maladaptively stored (or linked) 
        memory networks that can be successfully reprocessed with EMDR therapy. Siegel 
        describes EMDR therapy's efficacy from the perspective of interpersonal neurobiology, 
        explaining that the protocol contributes “...to the simultaneous activation of  previously 
        disconnected elements of neural, mental, and interpersonal processes...” which “...primes 
                 The	I–Gaze	Interweave	for	Attachment	Repair	in	EMDR	Therapy	                  2	
                 the system to achieve new levels of integration” (2007; p. xvii).  Similarly, Schore (2012) 
                 emphasizes the primacy of implicit, right brain-to-right brain affective communication 
                 and interpersonal regulation in therapy, which is also common to parent-child secure 
                 attachment experience.   
                  
                 Integrating old mental representations (e.g., insecure internal working models, or IWMs) 
                 with present-day experiences of safe attachment (e.g., in the therapy relationship) is a 
                 generally agreed upon condition for healing attachment trauma (Sandberg, 2010; Riggs, 
                 2010; Fosha, 2000).  IWMs reflect one's worthiness of care and protection, and serve up 
                 corresponding  predictions of the attachment figure's willingness and ability to offer care 
                 and protection (Solomon & George, 1999). Riggs explains that “IWMs function largely 
                 out of awareness, and therefore are resistant to change unless a conflict between the 
                 model and reality becomes extremely apparent” (2010, p.37). Repeated encounters with a 
                 secure therapist in which the IWMs are contradicted  can “provide opportunities for 
                 integrating dissociated mental models and fundamentally changing attachment patterns 
                 (Riggs, 2010, p. 37). 
                  
                 As Fosha (2000) points out, the care and attunement offered by the therapist is necessary 
                 but not sufficient: it must be received by the client for therapy to be effective. Therapy is 
                 a two-way street in which therapist and client create an interpersonal neurobiology of 
                 right brain-to-right brain experience, thereby inducing development and integration of the 
                 client's right brain implicit self (Schore, 2012; Siegel,  2007). The client must feel 
                 genuine care from the therapist––simply knowing it is not enough––and learn to tolerate, 
                 then eventually accept feeling cared about as safe and deserved.  The resulting earned-
                 secure attachment (Roisman, Padrón, Sroufe, & Egeland, 2002) with the therapist can 
                 usher in a transformation in the client's relationship with herself that involves greater self-
                 acceptance, greater affect tolerance, and improved ability to function in close 
                 relationship. 
                  
                 However, meeting the conditions  for earned-security is inherently fraught, particularly in 
                 the instance of unresolved (or disorganized) attachment. Such individuals suffer the cruel 
                 paradox of both needing to be witnessed by a caring and attuned other and at the same 
                 time fearing that very experience (Lamagna & Gleiser, 2007, Dalenberg, 2000). For 
                 many insecurely attached individuals, the compassion and closeness of the therapeutic 
                 relationship activates the client's attachment system which can trigger shame for 
                 depending on the therapist, fear of overwhelming the therapist by being too needy, 
                 disgust at being “seen” as defective, and fear of rejection and abandonment (Blizard, 
                 2003; Howell, 2005; Lamagna & Gleiser, 2007). These clients may experience 
                 themselves simultaneously as both “too much” (for anyone to be able to comfort or 
                 tolerate) and “not enough” (i.e., unworthy of care).   
                  
                 The process of working through these difficulties in phases 1–3 of EMDR therapy are 
                 beyond the scope of this paper and have been described elsewhere (e.g., Parnell, 2013). 
                 There is a nascent literature on the use of EMDR in the treatment of attachment trauma, 
                 limited to theoretical treatises and case studies (Wesselmann & Potter, 2009; 
                 Wesselmann, Davidson, Armstrong, Schweitzer, Bruckner, & Potter, 2012; Brown & 
                 The	I–Gaze	Interweave	for	Attachment	Repair	in	EMDR	Therapy	                  3	
                 Shapiro, 2006; Knipe, 2009). The focus here is on adapting phase 4 (desensitization) to 
                 the challenges of insecure attachment by utilizing a unique interweave designed to 
                 intensify the right brain-to-right brain communication prerequisite to facilitate earned 
                 security (Schore, 2015). The interweave involves direct eye-gazing between therapist and 
                 client while bilateral stimulation is administered (e.g., with tapping).   
                  
                 The significance of eye-gazing 
                 Human infants demonstrate an intense interest in eye-gazing by the 4th week of life, 
                 exhibiting among the earliest intentional behaviors from birth (Robson, 1967).  Eye-
                 gazing between mother and infant is a fundamental attribute of forming an attachment 
                 bond (Dickstein, Thompson, Estes, Malkin & Lamb, 1984). Infant eye-gaze triggers 
                 nurturing responses in the caregiver (Cozolino, 2014) by stimulating oxytocin production 
                 (Kim, Fonagy, Koos, Dorsett & Strathearn, 2014). Maternal nurturing, in turn, stimulates 
                 oxytocin production in the infant, thereby creating a positive feedback loop that enhances 
                 social reward (Dšlen, Darvishzadeh, Huang & Malenka, 2013), inhibits stress activity of 
                 the HPA axis (Neumann, 2002), and may improve dyadic interaction (Nagasawa, Okabe, 
                 Mogi & Kikusui, 2015;  Rilling & Young, 2014). While the affiliative effects of oxytocin 
                 have long been demonstrated in non-human social mammals (Nagasawa, Mitsui, En, 
                 Ohtani, Ohta, Sakuma, Onaka, Mogi, & Kikusui, 2012), it has also been shown in human 
                 couples interactions in which the administration of intranasal oxytocin reduced cortisol 
                 levels and increased cooperation in conflicting couples (Ditzen, Schaer, Gabriel, 
                 Bodenmann ,Ehlert & Heinrichs , 2009).   
                  
                 Mutual eye gaze can communicate aggression, romantic attraction, friendliness (Argyle 
                 & Cook, 1976) and respect or deference (Cozolino, 2014). Mutual eye-gaze facilitates 
                 social cognition: the affective and cognitive attribution process (i.e., theory of mind) that 
                 guides social interaction (Baron-Cohen, 1994, 1995).  Eye-gazing may be one of the 
                 earliest evolutionary components of theory of mind, a neurological process that activates 
                 the amygdala, anterior cingulate, and insula—a social-emotional network that may be 
                 involved in the experience of self (Cozolino, 2014).   
                  
                 The therapeutic relationship has been described as an attachment relationship in which 
                 the client's internal working model––openness to receive care and acceptance, 
                 expectations about the therapist's emotional availability, safety, etc.––are activated and 
                 recapitulated (Bowlby, 1988; Dworkin, 2005; Cozolino, 2014; Schore, 2012).  Secure 
                 attachment reflects attunement between the right-lateralized, implicit working models of 
                 both therapist and client.  Non-conscious decoding of the client's non-verbal 
                 communication (e.g., eye-gaze, facial expression, prosody) leads to genuine empathy in 
                 the therapist (Schore, 2003) and activates an implicit affect regulatory system in the client 
                 (Porges, 2009; Greenberg, 2007).   
                  
                 The I-Gaze Interweave: Rationale and Putative Mechanisms 
                 The I-Gaze interweave described here is an intervention designed to intensify this 
                 implicit communication by directly activating the client's attachment system through eye-
                 gaze. By its implicit nature, this intervention is an inherently intersubjective (Dworkin, 
                 2005), right brain-right brain experience. By eliminating the “noise” of more 
                 The	I–Gaze	Interweave	for	Attachment	Repair	in	EMDR	Therapy	                  4	
                 conventional social interaction, the client's visual input is narrowed to the analogue 
                 output of the therapist's eye-gaze communication. Moreover,  the client's normal 
                 strategies of regulating the relationship through social posturing is bypassed, leaving the 
                 client vulnerable to be seen unmasked.  Such naked, or innocent vulnerability is a 
                 recapitulation of the early attachment bond which can stimulate oxytocin-mediated affect 
                 regulation while providing “new” information during the client's maladaptively encoded, 
                 implicit working model of attachment.   
                  
                 The  empathy generated organically by the method's intense right-hemisphere dominated 
                 communication constitutes  “new,” real-time information to the client.  This contradicts 
                 the client's “old” information: rejection, dismissal, or contempt––residing in implicit 
                 autobiographical memory.  Thus, the dual attention aspect of the adaptive information 
                 model is conserved.  Bilateral stimulation is administered by tapping, the butterfly hug 
                 (Artigas, Jarero, Alcalá, & López Cano, 2009) or bilateral tones. When the client actually 
                 “sees”  and can receive the care and acceptance from the therapist, the mismatch between 
                 implicit expectation and actual sensation/perception creates a prediction error.  Prediction 
                 error creates a window of memory lability in which the dysfunctionally stored memory 
                 can be updated (Chamberlin, 2015; Ecker, Ticic & Hulley, 2012).   
                  
                  
                 INDICATIONS 
                 The proposed interweave is indicated for use in facilitating processing of attachment 
                 trauma characteristic of the Being vs. Nothingness Domain of Self Experience (Litt, 2008) 
                 when use of the standard protocol (Shapiro, 2001) seems insufficient, or clinical 
                 judgement suggests the utility of adding a dyadic resource. Litt (2008) describes three 
                 domains of self experience that encompass most if not all traumatic targets. In descending 
                 order of centrality to ego integrity, they are Being vs Nothingness, Merit, and Safety.   
                  
                 The first of these, and the subject of this paper, describes the presence of a stable self/not 
                 self boundary indicative of secure attachment. Trauma in this domain typically leads to 
                 relational dysfunction such as merger (Boszormenyi-Nagy, 1967), emotional 
                 dysregulation involving anxiety, fear, and shame, and depersonalization and 
                 derealization.  Phenomenologically, sufferers are hypersensitive to perceived 
                 abandonment and rejection: predicaments which can catapult them into a sense of 
                 existential aloneness (not to be confused with social isolation) in which the subject is 
                 irreparably defective, hopelessly cut off from the human order, and left with sense of 
                 purposelessness and nihilism. Negative cognitions representative of trauma in this 
                 domain include phrases such as I am alone, I am invisible, I am not real, I do not matter.   
                  
                 PROCEDURE  
                 Preparation 
                 The I–Gaze interweave is an intersubjective, or relational intervention (Dworkin, 2005) 
                 that is predicated on the therapist having an available earned secure attachment internal 
                 working model at the ready.  It is not a protocol that relies on technique alone. Failure to 
                 engage deeply in a felt-sense of acceptance and warmth could be counter-therapeutic, and 
                 therapists are advised to know themselves well enough to avoid this error.